Dr. Preeti Tandon
(Specialist Obstetrics & Gynaecology Laparoscopic & Robotic Surgeon. )

MBBS, MD(Obs/Gynae), F.MAS(Laparoscopic Surgeon), FICOG
Diploma in Adv Gynae Endoscopy (France), Certified Robotic Surgery Training (USA).

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Loop Electrosurgical Excision Procedure

Loop Electrosurgical Excision Procedure (LEEP)

Loop electrosurgical excision procedure (LEEP) involves using a wire loop to remove damages cells and tissues in women lower genital tract. This wire loop is heated by electric current. It is used in the process of diagnosis and treatment for cancerous situation.

The lower genital tract comprised of cervix and vagina. The lower part is being called cervix, and the narrow part of the uterus and the vagina acts as a connecting thread between the cervix and vulva.

In LEEP, an abnormal tissue is cut through the fine wire loop by which electric current passes through. Then this abnormal tissue will be sent to the lab for the testing purpose. This leads to the removal of abnormal cells and allow healthy tissues to grow.

LEEP can:

  •  Involves the removal of abnormal cervical tissue – seen during colposcopy.
  •  Leads to the removal of abnormal tissue high in cervical canal – that it is not visible during the course of colposcopy.

LEEP is also referred as the large loop excision of the transformation zone (LLETZ).

A vinegar or iodine solution and pave the way for more visibility for abnormal cells. It can be applied to the cervix just before the course of procedure.

How it is done

It is generally performed at your doctor’s office, or a hospital as an outpatient/inpatient procedure. For this procedure a patient don’t have to spend a whole day at the hospital.

One have to lie her back on an examination table with slightly raised feet by the support of footrests (stirrups). Your doctor will do insertion into the vagina through a tool (lubricated). This tool then spreads apart the walls of vaginal walls. It will allow surgeon to examine the vagina and cervix.

A specialized medicine is used to numb the cervix (cervical block). In case, if a cervical block involved, then some oral pain medicine given through the vein. A anesthetic can also be used here.

What to Expect After Surgery

Generally, in most of the cases, women are able to return to the normal routine within 1 to 3 days after LEEP. Recovery time also relies on the efficiency of the procedure.

After LEEP

  •  Some mild cramping may appear for some time duration.
  •  A dark brown vaginal discharge may occur.
  •  For 3 to 4 years, vaginal discharge or spotting may occur.
  •  Pads are highly recommendable in place of tampons for some time being.
  •  Sexual intercourse must be avoided for 3 to 4 weeks time.
  •  Douching must be avoided.

When to call your doctor

Call your doctor now or take immediate medical consult in case of :

  •  In case of severe bleeding from vagina. Many clots of blood may be passing and soaking through pads in course of every hour.
  •  Pain does not heel after taking medicine as well.
  •  Some strong signs of infection, like – Unbearable pain, Bad-smell vaginal discharge, or mild fever.

Why It Is Done

LEEP comes into being when cervical or some vagina issues appears during the course of the examination of pelvic, or unhealthy cells during the Pap test. LEEP is also used to detect cancer in the vagina or cervix. Cells, which referred as abnormal, but not cancerous in nature, maybe referred as precancerous. These abnormal cells may be the first evidence of cancer or can be develop into cancer after some time. Changes which are consider as abnormal may be minor cell changes called as low-grade squamous intraepithelial lesions (LSIL), maybe precancerous in nature, and emerge after a while.

LEEP may also be used to help in the diagnosis part or treatment of the following conditions:

  •  Polyps (benign growths)
  •  Genital warts, which may shows some infection signs with human papilloma virus (HPV), a crucial risk factor for developing cervical cancer.

Your healthcare consultant may have some other substantial reasons to recommend LEEP.

How Well It Works

LEEP is a very good treatment for the unhealthy cervical cell changes. During the course of LEEP, only a minimal amount of normal tissue is removed from the abnormal tissue area.

After LEEP, the removed tissue will go for the test of cancer that has gone deep into the cervical tissue. In this case, LEEP can help in diagnosis as well as treat the abnormal cells.

It is as effective as cryotherapy or laser procedures. In case, if all the abnormal cervical tissue is removed, no need to further surgery will required. However the count of abnormal cells may recue in the future course. Though studies have claimed that in some of the cases, the abnormal cells were removed in 98% of the cases.

Risks

  •  One may develop infection of the cervix or uterus.
  •  One may on the higher risk of delivering a premature baby.
  •  Excessive bleeding
  •  Removal of tissue may pave the way for scarring in cervix.
  •  Narrowing of cervix leads to some problems in getting pregnant.